This copy is for your personal non-commercial use only. To order presentation-ready copies of Toronto Star content for distribution to colleagues, clients or customers, or inquire about permissions/licensing, please go to: www.TorontoStarReprints.com

“The actual, serious ‘anti’ groups are a small percentage. But there is this other growing group of hesitant and questioning people who I think we really need to engage, because they’re still willing to change their mind one way or the other.”

For today’s public health officials, the headline published in this newspaper on Oct. 24, 1896, is the stuff of dreams: “Vaccination necessary and no one objects now.”

The article went on to say that society had finally come to accept vaccines after nearly a century of protest, “monster demonstrations” and even the jailing of parents who refused to vaccinate. By 1896, the “agitation seems to have died out and very little is heard in these days against the efficacy of vaccination.”

“Ultimately all these diseases which make such sad havoc in our homes will in time have to succumb to the scientists,” the report concluded.

Vaccines were first used more than two centuries ago against smallpox, one of the deadliest viruses. Today, smallpox has been eradicated and vaccines are recognized as one of medicine’s greatest achievements, preventing two to three million deaths every year, according to the World Health Organization.

Article Continued Below

But the controversy is far from over. In the years after that hopeful Evening Star headline, anti-vaccination sentiment in Toronto grew into a mass movement. And today more than a century later, health officials around the world are still wringing their hands over falling immunization rates, growing “anti-vax” sentiment, and the resurgence of preventable diseases like measles. British Columbia is currently experiencing its worst-ever outbreak, with more than 400 cases since March.

The anti-vaccination movement is often dismissed as a First World problem — a modern-day concern invented by the privileged and fuelled by misguided celebrities and too much time on the Internet.

But vaccine refusal is a phenomenon that occurs everywhere, from The Netherlands, where some religious communities oppose vaccinations, to Pakistan, where people administering polio vaccinations have actually been killed. And it existed long before entertainer Jenny McCarthy first blogged that vaccines are to blame for her son’s autism.

“As long as there have been vaccines there have been people who have been opposed to them,” says Daniel Salmon, deputy director of the Institute for Vaccine Safety at Johns Hopkins University. “Many of the same arguments back then, you hear today.”

Vaccines expose our bodies to a biological agent that mimics a specific pathogen, prompting our immune systems to develop antibodies that can fight off the real deal should it ever present itself.

Vaccines didn’t come into widespread use until the early 1800s but immunization is an ancient practice. In 10th century China, a man was reportedly immunized against smallpox “by having powder from pulverized smallpox scabs blown into his nostril,” according to the History of Vaccines, an educational website and online exhibit maintained by the College of Physicians of Philadelphia. There is also evidence that by the 18th century, Europeans were practicing “inoculation” — a process that involves nicking a child’s forearm with a “lancet wet with fresh matter taken from an exposed pustule,” according to a medical text from 1785.

Inoculation carried genuine risks, however. Some people did sicken and die, and the practice of passing infected matter from one person to another posed the risk of spreading other communicable diseases. People also opposed inoculation on religious grounds: The 18th{+ }century theologian Edmund Massey believed diseases were the will of God and preached against the “sinful practice of inoculation,” portraying Satan as the world’s first inoculator.

Vaccination as we understand it today was first widely practiced in the early 19th century — popularized after the fateful convergence of a milkmaid, a farm boy, and an English doctor who performed an experiment that would have never been approved by modern-day ethics boards.

Today’s scientists know that cowpox (a virus that causes lesions in cows but can also give people blisters and mild illness) is related to smallpox.

But in the 18th century, farmers only suspected that cowpox infections led to immunity against smallpox too. This theory wasn’t scientifically tested until 1796, when Dr. Edward Jenner took some cowpox pus from an infected milkmaid and inoculated an 8-year-old boy named James Phipps.

Two months later, Jenner infected Phipps again, this time with smallpox. The boy remained healthy.

Jenner published his findings in 1798 and by the turn of the century, the vaccine — a word derived from the Latin word vacca, or cow— was being used across most of Europe, with more than 100,000 people vaccinated by 1801. Controversy soon followed.

“Within five or 10 years, anti-vaccine movements had sprung up around England,” says Dr. Robert Wolfe, a clinical associate professor with the University of Chicago who has studied anti-vaccination movements. “But all of the arguments were very, very similar (to today): that vaccines cause diseases; that they spread illness and don’t prevent illness; that the whole vaccination thing was a hoax.”

But the fiercest opposition was unleashed when European governments began implementing mandatory vaccination policies. By 1821, vaccine refusal had become illegal in Bavaria, Norway, Sweden and Denmark, according to a paper in the Journal of Infectious Diseases. In 1853, England passed the Vaccination Act, making vaccines compulsory for all children under 3.

Parents who disobeyed the law were fined or even imprisoned. Anti-vaccine sentiment was already simmering but the laws added “fuel to the fire,” says Salmon of the Institute for Vaccine Safety.

“People who might not be opposed to vaccines per se might be opposed to having it required. You literally had people who were thrown out of their house and lost everything because they wouldn’t vaccinate.”

Anti-vaccination leagues started sprouting like smallpox lesions, disseminating their views through books, journals and pamphlets with such titles as the Anti-Vaccinator or Vaccination Inquirer. One political cartoon — which also appears on today’s anti-vaccination websites — depicts a baby-devouring monster named Vaccination whose “progressive havoc among the human race has been dreadful and most alarming.”

“People who have anti-vaccine sentiment have always been superb propagandists,” says Karie Youngdahl, director of the History of Vaccines project in Philadelphia.

The English city of Leicester was a particular hotbed of anti-vaccine activity, with 6,000 vaccine refusers were reportedly prosecuted in the 1870s and 1880s, according to a paper in the Archives of Disease in Childhood.

The largest public demonstration attracted as many as 100,000 activists, and police arrested dissenting parents to the jeers of angry crowds.

“An escort was formed, preceded by a banner, to accompany a young mother and two men, all of whom had resolved to give themselves up to the police and undergo imprisonment in preference to having their children vaccinated,” reported the Leicester Mercury. “In Gallowtreegate, three hearty cheers were given for them, which were renewed with increased vigour as they entered the doors of the police cells.”

The protests became too loud to ignore and a royal commission, lasting seven years, was struck. In 1898, a new Vaccination Act came into force, with an exemption for those who objected on philosophical or religious grounds — a decision that echoes to this day and introduced the world to the legal concept of the “conscientious objector.” It also meant vaccination rates plummeted: The following year, newspapers reported that fewer than 70 per cent of English newborns were being vaccinated; fewer than 3 per cent were vaccinated in Scotland.

Across the pond, anti-vaccination leagues had sprung up in Canada and the United States. In Toronto, these organizations lobbied for a conscientious exemption similar to England’s, according to Activists and Advocates, which details the early history of public health in Toronto. Some protested vaccination on the grounds that it targeted the working class; safety fears were also fuelled when children developed infections from unsanitary vaccination procedures or dirty bandages.

In 1914, the Ontario government made vaccinations mandatory during outbreaks to help stem the spread. When a smallpox epidemic broke out five years later, a throng of anti-vaccinationists protested outside city hall, hoisting signs that read “stop the slaughter of the innocents” and “compulsory vaccination German-born — down with compulsion!”

In a scene that demonstrated Toronto’s propensity for city-hall drama long before Rob Ford, a group of “antis” descended on a board of control meeting “in battle array” on Nov. 6, 1919, according to the Star.

Led by “prominent homeopathic physician” Dr. Henry Becker, they made fiery and not-entirely scientific deputations for why vaccines were a “crime,” winning over at least one city controller and prompting Toronto’s medical officer to storm out in “apparent disgust.”

The Star reported this exchange:

Becker: “We do not know today what the basis of the vaccination virus is … it has been made from the grease taken from the heels of horses, from swine-pox, and even from corpses.”

City Controller (and later mayor) Sam McBride: “From what?”

Becker: “From dead human bodies.”

McBride later concluded: “They can have my $25 (fine) right now. I won’t be vaccinated or require others to be.”

Today, the original anti-vaccination leagues no longer exist but their spirit lives on, especially online. Activists still protest compulsory vaccination but they also organize around terms like “vaccine injury” and “vaccine liberation.” While they no longer sing the anti-vaccination hymns of yore, these days we have bands like Seattle’s The Refusers, which sings about flu shots and “medical charlatans” making kids autistic.

Although horse-hoof grease is no longer a concern, vaccine opposers still worry about ingredients in their vaccines — nowadays they target additives such as thimerosal, which many anti-vaxxers have linked to autism. (The mercury-containing preservative has been phased out of most vaccines though scientists have found no credible evidence linking it to autism.)

“This opposition began with the first vaccinations, has not ceased, and probably never will,” Robert Wolfe and Lisa Sharp with the University of Chicago wrote in 2002 in an article published in the British Medical Journal.

But public health officials do worry anti-vaccine sentiment is growing. Between 2007 and 2012, the number of studies on anti-vaccination issues has doubled in Europe and the United States, according to a recent paper published in the journal Vaccine.

Lead author Heidi Larson says the environment has “vastly changed” since Victorian times. People have a growing distrust of doctors and the Internet isn’t helping matters; rumours on Google are effectively immortalized and misinformation can be shared quickly and across great distances.

People are also no longer divided into “anti” and “pro” camps. Rather, they exist along a spectrum of “vaccine hesitancy,” a phrase that more accurately describes the situation today, says Larson, who is leading a team at the London School of Hygiene and Tropical Medicine currently studying issues around public trust of vaccines.

“What has changed dramatically is the number and scope of vaccines that are available,” she says. “That drives a whole other questioning which is how many can we take? When is enough enough? How many do we really need?

“The actual, serious ‘anti’ groups are a small percentage,” she continues. “But there is this other growing group of hesitant and questioning people who I think we really need to engage, because they’re still willing to change their mind one way or the other.”

Many parents today also never experienced the fear that came with outbreaks of diseases like polio before vaccines came along. The reasons for vaccine opposition also vary considerably, meaning tackling it has become far more complex, Larson says. Her recent paper found that in India, educated parents are more likely to vaccinate; in countries like China, Bangladesh and the United States, the opposite is true — education is a potential barrier to vaccination. In India, knowledge about vaccine recommendations promoted acceptance; in China and the Democratic of Congo, it’s a barrier.

Larson’s group is working to better understand why people refuse vaccinations. They are also developing a system to identify hot spots where these sentiments may be reaching dangerous levels. “Why is it that in certain settings, the same rumour can fizzle and die but in others, they lead to a statewide boycott?”

Some researchers believe health workers must work on engaging better with patients and confronting the reality that vaccines, like all medications, are never 100-per-cent risk free. Ignoring vaccine-hesitant parents will only push them toward those willing to listen — and often they are anti-vaxxers with the most radical views.

“It’s that feeling of I’m always right and you have to do what I tell you,” says Wolfe with the University of Chicago. “I think that attitude hurts public health.”

So while the Star may have erred in its 1896 suggestion that opposition to vaccination was over, it perhaps showed more wisdom in an editorial published 10 years later.

The editorial noted anti-vaccination campaigners were vigorous in voicing their views but medical men “have made the prime mistake of despising the enemy,” largely refusing to respond.

“Their case is strong; they have made the mistake of supposing it to be self evident,” the editorial said. “If, therefore, medical scientists wish the people to retain their faith in vaccination they must keep them constantly supplied with facts and arguments, and must be ready to meet the opposition, not angrily, but patiently.”

Delivered dailyThe Morning Headlines Newsletter

The Toronto Star and thestar.com, each property of Toronto Star Newspapers Limited, One Yonge Street, 4th Floor, Toronto, ON, M5E 1E6. You can unsubscribe at any time. Please contact us or see our privacy policy for more information.

More from the Toronto Star & Partners

LOADING

Copyright owned or licensed by Toronto Star Newspapers Limited. All rights reserved. Republication or distribution of this content is expressly prohibited without the prior written consent of Toronto Star Newspapers Limited and/or its licensors. To order copies of Toronto Star articles, please go to: www.TorontoStarReprints.com